*Purpose: Potential kidney transplant recipients over the age of 65 years of age form a significant proportion of the total referred for kidney transplant evaluation. Pre-kidney transplant evaluation is a detailed process that ties up resources in any healthcare organisation . This group presents a significant challenge to the kidney transplant community, in view of the prevalent comorbidities and the extensive pre-transplant workup required. We aimed to investigate the outcome of potential kidney transplant recipients over the age of 65 years accepted for kidney transplant evaluation in one of the largest transplant centres in Saudi Arabia.

*Methods: We undertake the full pre-kidney transplant evaluation for all potential recipients referred to our centre. Our study included the retrospective analysis of data from an electronic database of all patients above 65 years referred for kidney transplant in our centre between September 2009 and December 2019.

*Results: A total of 373 patients aged 65 years or over were referred to our centre for pre-kidney transplant evaluation which represent around 10 % of the total referred, 41.6% of them were females. 81 patients (21.7%) underwent kidney transplant during the study period (living donor (LD) 72, deceased donor (DD) 9). This is compared to 1207 kidney transplants in the below 65 years of age group (34.5%), among whom 946 had LD and 261 DD transplants. The annual transplant rate from DD was 0.8 per year in over 65 years old vs 23.7 in the lower age group . 292 patients were not transplanted in the over 65 years group (173 (59.2%) were considered unsuitable transplant candidates, 20 (6.8%) remain on work-up, 12 (4.1%) listed on DD waiting list, and 87 (29.8%) were on a list awaiting to undergo full pre-kidney transplant workup from deceased donors). The median work up time for those underwent LD transplant among this age group was (317 days , range:21-2456) and in the lower age group ( 273 days , range :20-3004) Mortality in this age group who were actively started work up was 15% in comparison to 8% in the lower age group.

*Conclusions: Over 65 years old ESRD patients have a lower kidney transplant rate compared to younger patients specially from deceased donors as well as they have relatively longer work up time. A move towards more of the pre-kidney transplant evaluation to be done at patients’ own nephrology units is suggested, in order to avoid tying up resources at the transplant centre, while not denying this increasing group of ESRD patients the benefits of kidney transplantation.

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